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New report says families priced out of Fair Deal nursing homes

Published 05/07/2017

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A new briefing paper on nursing home charges published today says that older people and their families are being prevented from choosing nursing homes under the Fair Deal scheme because of additional charges.

Age Action, Ireland’s leading advocacy organisation for older people, includes statements from social workers working with older people and case studies from the families of nursing home residents in the paper to support calls for greater transparency and accountability.

Justin Moran, Head of Advocacy and Communications, said: “One of the key principles of the Fair Deal scheme is that older people have choice. No one is prevented from choosing the nursing home they prefer because of their incomes.

“But steadily increasing charges imposed by nursing homes are pricing older people and their families out. 

“When someone on the State Pension is left with only €50 a week after making their contribution under Fair Deal they are simply not going to be able to afford a nursing home charging €200 a month for social activities.” 

Supported by social workers

Age Action’s claims are backed up by statements from social workers working with older people.

One social worker told Age Action: “A family I have been working with has just spent days visiting nursing homes in the south Dublin and Wicklow area. They’re being quoted extra charges of €85 a week and they simply can’t afford that.”

Another social worker said: “I have one patient whose family just can’t pay anything extra and because of this she is now on the waiting list for a public nursing home bed.”

Case studies

The report also contains two case studies from members of the public who contacted Age Action regarding the costs being imposed by nursing home management.

Michelle’s mother found herself being charged for a “Doctor’s Service” even though she has a full medical card. The nursing home refused to provide an itemised bill and, after it was confirmed to Michelle that such a charge was illegal, she engaged a solicitor.

Conor’s mother has a long list of additional services for which she is being charged that will cost almost €4,500 a year in addition to what is being paid under the Fair Deal Scheme.

Families caught in the middle

Justin Moran continued: “Nursing homes insist that they have to pass on these charges because the National Treatment Purchase Fund does not cover the costs of the services they provide or that HIQA has instructed them to put in place.

“There is some truth to this but while nursing homes and the NTPF argue over euros and cents, it’s nursing home residents and their families who are paying the real cost.

“And even that argument doesn’t excuse the extortionate costs some nursing homes impose, including for services that residents are physically unable to use.”

Age Action's proposals

Last week Age Action met with Minister of State with Responsibility for Mental Health and Older People Jim Daly TD to discuss nursing home charges.

Justin Moran continued: “We had a good meeting with the Minister and I’m convinced he wants to work with us and with nursing homes’ representatives to put in place a fairer and more transparent system.”

Age Action’s proposals fall into three main categories:

  • Transparency: The fees charged by nursing homes should be publicly available online, easy to understand and it should be clear what service a resident is getting for the money they pay.
  • Accountability: Nursing home charges must be properly regulated to ensure there is no overpricing and residents informed they can take complaints over fees to the Office of the Ombudsman and be empowered to do so.
  • Income: Nursing home residents with an assessed income of €300 or less should be allowed retain a minimum of €60 to enable them to cover day-to-day living costs instead of the current €44.40.
 

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The new Bill is an inadequate response to the growing demand for the abolition of mandatory retirement.

According to Dr Nat O’Connor, Age Action’s Senior Policy Adviser: “Age Action strongly opposes the revival of the Employment (Restriction of Certain Mandatory Retirement Ages). Bill 2024, which is an inadequate response to the growing demand for the abolition of mandatory retirement.”

“Across political parties, in unions and among older persons, we see support for ending the practice of forcing people out of work before they are ready, but the proposed Bill makes no meaningful progress toward that end. The aim set out in its title, to restrict certain mandatory retirement ages, betrays its lack of ambition. All it provides for is the establishment of a complex, formal procedure so that employees can make a written request to stay on past their contractual retirement age; a request which can still be denied by their employer. This is the sole ‘restriction’ the Bill would impose on mandatory retirement.”

“This is a weak and ineffective Bill which is unlikely to help most employees who are forced out of work against their will for the offence of reaching a certain birthday. There is no reason for such timid action when we have seen other countries like Canada, New Zealand, Australia, the UK, and the United States abolish mandatory retirement entirely, in some cases decades ago. These countries have continued to enjoy well-functioning and productive labour markets and workplaces, showing that there is no foundation for the fears expressed by people who want to keep mandatory retirement.”

“Mandatory retirement is age discrimination. If the State allows a form of discrimination to be practiced, it must set out clear justifications for the practice. However, the popular arguments in favour of mandatory retirement are all myths. There is no evidence that older persons are less able to contribute to a workplace, or that they cost more than they contribute, or that they prevent younger workers from gaining employment. In fact, research has demonstrated the many benefits older workers bring to workplaces, including institutional experience, mentoring, and soft skills like better stress management.”

“Mandatory retirement is based on gross and insulting stereotypes about ageing. It is experienced by workers as a humiliating and dehumanizing injustice. It takes away our autonomy and our control over how and when we retire, which is a major life event. People who had no choice in retiring report poorer mental health, life satisfaction, health status, dietary habits, marital satisfaction, self-efficacy, and income adequacy, even years into their retirement.”

Dr. O’Connor concluded: “The proposed Bill is an incomplete and inadequate response to the problem of mandatory retirement, and by virtue of its incompleteness, reinforces and legitimises the dangerous ageism on which mandatory retirement is founded. We want our new government to take strong and decisive action, rather than tinkering around the edges of a serious problem. The Bill needs to be abandoned in favour of legislation that really helps the workers who wish to remain in work for longer.”

Churn:
It is not reasonable to suggest that the abolition of mandatory retirement would create a large problem for companies, when the scale of churn in the labour market is already far higher. The Irish labour market experienced 12.8% churn in quarter 3 of 2024, meaning that 1 in 8 jobs were created, abolished or vacated during this period, which was 365,750 jobs (Central Statistics Office 2024).

Compared to this level of hiring and resignations, managing the relatively small number of older workers who may seek to work longer or whose productivity may fall in older age is a much smaller human resources management issue for companies.

CSO (2024) Labour Market Churn Q3 2024 https://www.cso.ie/en/releasesandpublications/fp/fp-lmc/labourmarketchurnq32024/

Age Action’s detailed policy paper outlining the case against mandatory retirement can be accessed here: https://www.ageaction.ie/sites/default/files/age_action_paper_abolish_mandatory_retirement.pdf